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BackgroundRepeat hepatectomy is an acceptable treatment for recurrent hepatocellular carcinoma (HCC). However, repeat laparoscopic liver resection (LLR) has not been widely adopted due to its technical difficulty. This study aimed to assess the feasibility and efficacy of repeat LLR compared with repeat open liver resection (OLR) for recurrent HCC.MethodsWe performed 42 repeat OLR and 30 repeat LLR for cases of recurrent HCC between January 2007 and March 2018. This study retrospectively compared the patients’ clinicopathological characteristics and operative and short-term outcomes including surgical time, intraoperative blood loss, duration of hospital stay, and postoperative complications between the two groups.ResultsThere were no significant differences in patient characteristics between the two groups except in terms of Child–Pugh grade. The repeat LLR group had lower median intraoperative blood loss (100 mL vs. 435 mL; P = 0.001) and shorter median postoperative hospital stay (10 days vs. 14.5 days; P = 0.002). The other results including postoperative complications were comparable between the two groups. Further, comparison of two subpopulations of the repeat LLR group stratified by previous hepatectomy type (open or laparoscopic) or tumor location (segments 7 and 8 or other) revealed no significant differences in the postoperative clinical characteristics between them, although the morbidity rate tended to be higher in patients who underwent open hepatectomy for primary HCC than in patients who underwent laparoscopic hepatectomy.ConclusionsRepeat LLR for recurrent HCC is feasible and useful with good short-term outcomes although an appropriate patient selection seems to be necessary.

Abstract BACKGROUND Recurrence rates for atypical and anaplastic meningiomas range between 9% and 50% after gross total resection and between 36% and 83% after subtotal resection. Optimal treatment of recurrent meningiomas exhibiting atypical/anaplastic histology is complicated because they are often refractory to both surgery and radiation. OBJECTIVE To evaluate clinical determinants of recurrence and treatment-specific outcomes in patients with recurrent meningiomas exhibiting atypical/anaplastic histology at our institution. METHODS A cohort study was conducted using clinical data of all patients treated for meningiomas with atypical/anaplastic histology at first recurrence between January 1985 and July 2014 at a tertiary cancer center. Predictors of second recurrence were analyzed using competing risks regression models. RESULTS Nine hundred eighteen patients with meningioma were screened, of whom 60 (55% female) had recurrent disease with atypical/anaplastic histology at a median age of 58.1 yr at diagnosis. The median follow-up from the time of first recurrence was 36.7 mo, with 32 (53%) patients alive at last follow-up. There was no effect of extent of resection at first recurrence on time to a subsequent recurrence. Inclusion of radiation as primary or adjuvant therapy at first recurrence reduced the risk of progression or subsequent recurrence compared to surgery alone (P = .07). CONCLUSION Treatment of recurrent meningiomas with atypical/anaplastic histology remains challenging. Our data, from one of the largest cohorts, suggest better tumor control with the addition of radiation and challenges the importance of extent of resection at first recurrence. A multicenter effort is needed to confirm these findings and propose treatment guidelines.

Roux-en-Y hepaticojejunostomy is a crucial procedure for treating biliary diseases, especially in patients with recurrent hepatolithiasis. However, the safety and efficacy of repeat laparoscopic Roux-en-Y hepaticojejunostomy(R-LRHJS) remain controversial due to the complexity of hepatobiliary stones and the potential for complications. A total of 41 patients admitted to the Department of Hepatobiliary Surgery at the Second Affiliated Hospital of Kunming Medical University from June 2019 to December 2023 were reviewed. 20 patients who underwent repeat R-LRHJS were included in the final analysis. Surgical techniques emphasized meticulous dissection of intra-abdominal adhesions, precise identification of the hepatic hilum bile duct, and careful reconstruction of the biliary-enteric anastomosis. The mean patient age was 54.6 ± 10.7 years. Operative time ranged from 120 to 378 min, with intraoperative blood loss between 10 and 200 ml. Postoperative complications included anastomotic bleeding (2 cases), pancreatic stump bleeding (1 case), duodenal fistula (1 case), and biliary leakage (5 cases). No perioperative deaths occurred. During a 1- to 3-year follow-up, no recurrence of anastomotic stenosis or stone formation was observed on MRCP. The study concludes that R-LRHJS is a feasible and effective treatment for recurrent biliary strictures or stones following initial choledochojejunostomy.

Introduction and purpose Re-intervention, either transsphenoidal surgery or radiotherapy, is suggested in patients who are not in remission after primary surgery for acromegaly; however, the evidence is weak. We aimed to assess the remission rate after re-intervention, and complications compared to a comparison group who had undergone primary interventions only. Methods Patients diagnosed with acromegaly between 2005–2021 at Oslo University Hospital were screened for inclusion. The study cohort included patients with two or more interventions. The comparison group included patients not in remission after primary surgery. Results Of 223 patients with acromegaly, 42 underwent re-interventions (study cohort). At diagnosis, median age was 38 (IQR 29–48) years and 41 patients (98%) had a macroadenoma. The comparison group consisted of 49 patients, median age 54 (IQR 44–60) years and 37 (76%) had a macroadenoma at diagnosis. Re-interventions in the study cohort consisted of surgery, radiotherapy and a combination of these (22, 12 and eight patients). After re-interventions, 22 patients (52%) were in remission and 12 (29%) had reduced disease activity. Seven patients (17%) acquired new hormone deficiencies, two of them corticotroph deficiency. One patient in remission developed spinal fluid leakage and meningitis. There was no significant difference in complications after surgery between the study cohort and the comparison group. Conclusion Re-interventions were safe and resulted in remission or substantial improvement in most patients. Re-intervention should be considered for patients who would otherwise require lifelong medical treatment.

BackgroundTo examine the factors contributing to persistent and recurrent hemifacial spasms (HFS) following a microvascular decompression (MVD) procedure and to suggest technical improvements to prevent such failures.MethodsA retrospective review was conducted on fifty-two cases of repeat surgery. The extent of the previous craniotomy and the location of neurovascular compression (NVC) were investigated. The operative findings were categorized into two groups: “Missing Compression” and “Teflon Contact”. The analysis included long-term outcomes and operative complications after repeat MVD procedures.ResultsMissing compression was identified in 29 patients (56%), while Teflon contact was observed in 23 patients (44%). Patients with missing compression were more likely to experience improper craniotomy (66%) compared to those with Teflon contact (48%). Medially located NVC was a frequent finding in both groups, mainly due to compression by the anterior inferior cerebellar artery. In the missing compression group, during the repeat MVD, Teflon sling retraction was utilized in 79% of cases, while in the Teflon contact group, the most common procedure involved removing the Teflon in contact (65%). After the repeat MVD procedure, immediate spasm relief was achieved in 42 patients (81%), with six (12%) experiencing delayed relief. After a median follow-up of 54 months, 96% of patients were free from spasms. Delayed facial palsy, facial weakness, and hearing impairment were more frequently observed in the Teflon contact group.ConclusionsA proper craniotomy that provides adequate exposure around the REZ is crucial to prevent missing the culprit vessel during the initial MVD procedure. Teflon contact on the REZ should be avoided, as it poses a potential risk of procedure failure and recurrence.

ObjectiveTo investigate the visual outcomes and optimal timing for repeat surgery in cases of postoperative hematoma following transsphenoidal surgery for pituitary neuroendocrine tumors (PitNETs).MethodsA retrospective study was conducted on 28 patients who developed evident postoperative hematoma out of a total of 9,010 patients. The hematomas were classified into three types based on their CT appearance. Type 1a - mild high density with no tension, Type 1b - thin-layer high density; Type 2a - solid high density with large empty cavities, Type 2b - solid high density with small empty cavities; Type 3 –solid high density with no cavity showing high tension. Patient data were collected for analysis.ResultsThe study cohort comprised 10 female and 18 male patients, with a mean age of 51.5±11.9 years. Most patients presented with large adenomas (median diameter 36mm). Postoperative visual sight improved in 12 patients, remained stable in 11 patients, and worsened in 5 patients. Notably, no patients experienced worsened visual sight beyond twenty-four hours after the operation. Among the five patients with visual deterioration, four had CT type 3 hematoma (4/6, 66.7%), and one had CT type 2b hematoma (1/9, 11.1%). Patients in the type 3 CT group were significantly more prone to experience visual deterioration compared to those in the type 2 group (odds ratio [OR] 2.154 [95% CI 1.858-611.014], P=.027). Four patients underwent repeat surgery after visual deterioration, resulting in visual improvement following a prolonged recovery period. Postoperative hematoma had limited impact on pituitary dysfunction and hyponatremia.ConclusionOur study reveals a significant association between postoperative hematoma CT types and visual deterioration. For patients with stable visual sight and type 1 or 2a hematoma, conservative strategies may be considered. Conversely, type 2b and 3 patients are at higher risk of visual deterioration, especially within the first 24 hours after the operation. Consequently, early reoperation before vision worsens may be a prudent approach to reduce risks and improve visual outcomes, particularly in type 3 patients.

Fundamentals of Revision Knee Arthroplasty: Diagnosis, Evaluation, and Treatment is a unique and very timely book designed for surgeons who are beginning to more commonly encounter knee revisions in their practice. Unlike many traditional books on revision, Fundamentals of Revision Knee Arthroplasty does not focus on the most difficult and challenging of cases. Rather, Fundamentals of Revision Knee Arthroplasty is intended to guide the surgeon in the evaluation of the failed or painful total joint replacement, review basic tenants and surgical principles of revision arthroplasty, and guide the surgeon in determining whether a given case is one that should be managed or is best referred to a tertiary orthopedic center. Along with their 32 contributors, Dr. David J. Jacofsky and Dr. Anthony K. Hedley provide detailed information inside Fundamentals of Revision Knee Arthroplasty , including appropriate preoperative evaluation, equipment requirements, surgical planning, need for augments and allograft, and surgical techniques. Surgeons will be tackling knee revision surgery more frequently as the number of these cases is exponentially increasing. Fundamentals of Revision Knee Arthroplasty provides a \"go-to\" resource to turn to for guidance by community arthroplasty surgeons, arthroplasty fellows, and residents.

PurposePatients often undergo repeat surgery for endometriosis, due to recurrent or residual disease. Previous surgery is often considered a risk factor for worse surgical outcome. However, data are scarce concerning the influence of subsequent endometriosis surgery.MethodsA retrospective study in a centre of expertise for endometriosis was conducted. All endometriosis subtypes and intra-operative steps were included. Detailed information regarding surgical history of patients was collected. Surgical time, intra-operative steps and major post-operative complications were obtained as outcome measures.Results595 patients were included, of which 45.9% had previous endometriosis surgery. 7.9% had major post-operative complications and 4.4% intra-operative complications. The patient journey showed a median of 3 years between previous endometriosis surgeries. Each previous therapeutic laparotomic surgery resulted on average in 13 additional minutes (p = 0.013) of surgical time. Additionally, it resulted in more frequent performance of adhesiolysis (OR 2.96, p < 0.001) and in a higher risk for intra-operative complications (OR 1.81, p = 0.045), however no higher risk for major post-operative complications (OR 1.29, p = 0.418). Previous therapeutic laparoscopic endometriosis surgery, laparotomic and laparoscopic non-endometriosis surgery showed no association with surgical outcomes. Regardless of previous surgery, disc and segmental bowel resection showed a higher risk for major post-operative complications (OR 3.64, p = 0.017 respectively OR 3.50, p < 0.001).ConclusionPrevious therapeutic laparotomic endometriosis surgery shows an association with longer surgical time, the need to perform adhesiolysis, and more intra-operative complications in the subsequent surgery for endometriosis. However, in a centre of expertise with experienced surgeons, no increased risk of major post-operative complications was observed.

Fundamentals of Revision Hip Arthroplasty: Diagnosis, Evaluation, and Treatment is a unique and very timely book designed for surgeons who are beginning to more commonly encounter hip revisions in their practice. Unlike many traditional books on revision, Fundamentals of Revision Hip Arthroplasty does not focus on the most difficult and challenging of cases. Rather, Fundamentals of Revision Hip Arthroplasty is intended to guide the surgeon in the evaluation of the failed or painful total joint replacement, review basic tenants and surgical principles of revision arthroplasty, and guide the surgeon in determining  whether a given case is one that should be managed or is best referred to a tertiary orthopedic center. Along with their 32 contributors, Dr. David J. Jacofsky and Dr. Anthony K. Hedley provide detailed information inside Fundamentals of Revision Hip Arthroplasty , including appropriate preoperative evaluation, equipment requirements, surgical planning, need for augments and allograft, and surgical techniques. Surgeons will be tackling hip revision surgery more frequently as the number of these cases is exponentially increasing. Fundamentals of Revision Hip Arthroplasty provides a 'go-to' resource to turn to for guidance by community arthroplasty surgeons, arthroplasty fellows, and residents.

Background Despite surgical and pharmacological interventions, endometriosis can recur. Reliable information regarding risk of recurrence following a first diagnosis is scant. The aim of this study was to examine clinical and survey data in the setting of disease recurrence to identify predictors of risk of endometriosis recurrence. Methods This observational study reviewed data from 794 patients having surgery for pelvic pain or endometriosis. Patients were stratified into two analytic groups based on self-reported or surgically confirmed recurrent endometriosis. Statistical analyses included univariate, followed by multivariate logistic regression to identify risk factors of recurrence, with least absolute shrinkage and selection operator (Lasso) regularisation. Risk-calibrated Supersparse Linear Integer Models (RiskSLIM) and survival analyses (with Lasso) were undertaken to identify predictive features of recurrence. Results Several significant features were repeatedly identified in association with recurrence, including adhesions, high rASRM score, deep disease, bowel lesions, adenomyosis, emergency room attendance for pelvic pain, younger age at menarche, higher gravidity, high blood pressure and older age. In the surgically confirmed group, with a score of 5, the RiskSLIM method was able to predict the risk of recurrence (compared to a single diagnosis) at 95.3% and included adenomyosis and adhesions in the model. Survival analysis further highlighted bowel lesions, adhesions and adenomyosis. Conclusions Following an initial diagnosis of endometriosis, clinical decision-making regarding disease management should take into consideration the presence of bowel lesions, adhesions and adenomyosis, which increase the risk of endometriosis recurrence.